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Introduction to Individual Health Behavior Theories

COH604: Theories of Health Behavior

Overview

Introduction

Overview of Individual-Level Theories

Commonalities Across Theories

Selecting the Appropriate Theory

Summary

Introduction

Individual-level theories can assist in the:

Identification of upstream determinants of health behaviors

Design and evaluation of health behavior change interventions

Introduction

Theories covered in this section include:

The Health Belief Model

The Theory of Planned Behavior/Theory of Reasoned Action

The Integrated Behavioral Model

The Transtheoretical Model

Overview of Individual-Level Theories

Health Belief Model (HBM)

Assumes that health behaviors are influenced by the perceived likelihood and severity of a threat as well as the perceived benefits and barriers of taking action

Cues to action are factors that instigate action and are terminology unique to the HBM

Examples: medical symptoms, doctor’s recommendation, advertisement

Health Belief Model (HBM)

Self-efficacy is the belief that one can successfully execute a behavior

It is a strong predictor of many health behaviors, however few studies have investigated its predictive utility

Substantial empirical support exists for the HBM in predicting health behaviors in cross-sectional studies

Evidence also exists, although to a lesser extent, in experimental intervention studies

Theory of Planned Behavior (TPB), Theory of Reasoned Action (TRA), Integrated Behavioral Model (IBM)

These theories provide a systematic method for identifying issues important to decisions about performing specific behaviors

All three assume that attitudes, subjective norms, and perceived behavioral control affect behavioral intentions, which are linked to behavior

Many attitudes are modifiable and therefore ideal targets for intervention

Theory of Planned Behavior (TPB), Theory of Reasoned Action (TRA), Integrated Behavioral Model (IBM)

Behavioral intention measures should closely match the target behavior

Measurement requires precision and detailed work

Longitudinal studies have found strong intention-behavior relationships

Rigorous experimental studies have found significant small to moderate effects

However, intentions do not always translate to behavior and should not be used as a proxy for behavior or behavior change

Transtheoretical Model (TTM)

Posits that people are in different stages of readiness to make health behavior changes

Each stage is different with respect to the constructs and process that move people closer to a behavior

Individuals should receive the intervention appropriate for their stage in the behavior change process

Transtheoretical Model

The TTM is one of the most widely used behavior change models

The inclusion of processes of change is a strength of the TTM

More studies are needed to measure the effectiveness of stage-matched interventions

Commonalities Across Theories

Many individual-level theories have similar constructs

Examples:

HBM, TPB, TRA, and IBM include perceived barriers

TTM, IBM, and HBM include self-efficacy

All require careful attention to measurement of key variables

Should use standard questions and formats when available

Selecting the Appropriate Theory

Start by thinking about the target behavior

Even though each theory can be adapted to different behaviors, each was developed for specific and distinct behavior types

It is also important to consider higher-level determinants of health behaviors

Example: social determinants of health

Selecting the Appropriate Theory

It is common to combine or blend theories

Should be done systematically and thoughtfully

Aided by the development of a logic model

It is useful to map measures directly onto intervention components

Can do this by creating a table of key constructs and examining them in relation to the intervention components

Selecting the Appropriate Theory

Challenges

Few studies have compared theories

Emotions influence behaviors, but are not included in individual-level theories

More attention to behavior change and maintenance are needed:

Implementation intention interventions encourage the specification of when and under what conditions individuals engage in a specific behavior

Behavior change and behavior maintenance may require the use of distinct constructs and measures

Summary

Theories that emphasize individual behavior are important in understanding how to improve health

However, they are not appropriate or sufficient to address all health problems

Community and social contexts also influence beliefs and behaviors

It is important to consider the nature of the health problem or condition before selecting the most appropriate theory or theories

References

Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior: Theory, research, and practice (5th ed.) San Francisco, CA: John Wiley & Sons